Picture this: A radiologist performing a routine sonogram during a woman's 18th week of pregnancy notices questionable findings of osteogenesis imperfecta (OI) but informs the patient that the sonogram is normal. A 27-week sonogram, however, indicates clear-cut evidence of OI. The parents learn that the radiologist did not disclose his original suspicion and file a "wrongful birth" malpractice lawsuit, alleging that if they had known, they would have terminated the pregnancy. The parents' attorney tells the jury, "When a physician withholds information from a patient, that's malpractice."

The scenario is the plot of Jodi Picoult's novel, "Handle with Care." The book is fiction but "wrongful birth" lawsuits are not. Litigation arising from a physician's failure to apprise parents of debilitating congenital abnormalities, thus precluding consideration of abortion or in-utero corrective surgery, is on the rise.

Radiologists observe questionable abnormalities on all types of studies. The nodule in the fifth interspace on a chest radiograph is almost certainly a nipple, and a localized kidney bulge seen on abdominal CT is a normal contour, or are they small tumors? Infinite "variations of normal" could represent small malignancies or early manifestations of disease.

Should radiologists ignore all questionable abnormalities, reporting only those they reasonably believe are significant? Courts have held that radiologists should anticipate patients wanting to be informed of any abnormality. Regarding obstetrical sonographic findings extremely unlikely to represent significant abnormalities, Roy Filly, M.D., of the University of California in San Francisco, wrote: "Should I have the courage of my conviction to simply ignore these features? I wish I had that courage but I don't. Even with my considerable clout in the world of obstetrical sonography, I cannot unilaterally ignore them. That is not how American medicine works."

Dr. Filly is correct. Notwithstanding Shakespeare's observation that "Conscience does make cowards of us all," I suggest that the question in the title of this column be answered affirmatively.

Leonard Berlin, M.D., is a professor of radiology at Rush Medical College in Chicago and vice-chair of the Department of Radiology at NorthShore University HealthSystem – Skokie Hospital in Skokie, Ill. Dr. Berlin, who chairs the RSNA Professionalism Committee, discusses the impact of medical malpractice on breast imaging in a feature in this month's RSNA News.